| NPI | 1285774240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101-0018823) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 393924-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN281492) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 059130-23) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2009-08-11 |